Prescribing

Question 1

Definition

What is “adherence”?

Answer 1

The extent to which the patient’s behaviour matches agreed recommendations from the prescriber

This has been changed from “compliance” as it presents the role of the patient as a passive recipient. Non-compliance may be interpreted as incompetence on the part of the patient or the patient willfuly engaging in harmful behaviour

Question 2

What is “concordance”?

Answer 2

A process of prescribing and medicine-taking based on partnership

Concordance graphic

Question 3

What are the five dimensions that affect adherence, as defined by WHO?

Answer 3

Social/economic factors
Health systems/healthcare team factors
Therapy-related factors
Patient-related factors
Condition-related factors

Question 4

Give an example of a social/economic factor that affects adherence

Answer 4

Age, sex, inability to pay for medicines

Question 5

Give an example of health system/healthcare team factors that may affect adherence

Answer 5

Poor quality instructions provided to the patient

Question 6

Give an example of therapy-related factors that may affect adherence

Answer 6

Adverse effects, complex drug regimens

Question 7

Give an example of patient-related factors that may affect adherence

Answer 7

Patient disagreeing with necessity of treatment, low self-esteem

Question 8

Give an example of condition-related factors that may affect adherence

Answer 8

Dysphagia in myasthenia gravis

Question 9

What is a subjective strategy for measuring medication adherence?

Answer 9

Assessing adherence based on patient’s self-report

Question 10

Common prescriptions

What dose and route of adrenaline should be prescribed in acute anaphylaxis in an adult?

Answer 10

500 micrograms IM

Question 11

Drug allergies

In allergic drug reactions, what mediates the symptoms?

Answer 11

Histamine release from mast cells.
Mast cells are activated either by IgE or directly by the drug

Question 12

Drug allergies

What are the symptoms of a Type 1 allergic drug reaction?

Answer 12

Urticaria, itching, angioedema, bronchospasm and hypotension

Question 13

Drug allergies

How soon after administering the drug do the symptoms of an allergic reaction occur?

Answer 13

30 minutes (up to 2 hours), may not be after the first dose of the drug
Parenterally administered drugs have a median time to cardiac arrest of 5 minutes from the first symptoms in extreme reactions

Question 14

Drug allergies

What should you do after a patient has presented with a serious allergic reaction to drugs (after managing them)?

Answer 14

Report to the Yellow Card Scheme

Question 15

Which class of drugs is well-known to exacerbate asthma?

Answer 15

NSAIDs

Question 16

Which of these antibiotic classes should you avoid in a patient with a penicillin allergy?

1. First generation cephalosporin (cefalexin)
2. Second generation cephalosporins (cefuroxime)
3. Third generation and subsequent cephalosporins (ceftriaxone, cefotaxime)
4. Carbapenems (doripenem, ertapenem, meropenem)
5. Monobactams (aztreonam)

Answer 16

Avoid cephalosporins and carbapenems

Question 17

How long should a patient be observed for after an anaphylactic reaction?

Answer 17

6-12 hours

Question 18

A patient has an allergic drug reaction to an ACE inhibitor. What should you do about this prescription?

Answer 18

Switch to an angiotensin-II receptor antagonist

Question 19

List the risk factors for developing an allergic reaction to drugs

Answer 19

Atopic individuals
Co-existing conditions (HIV, EBV, CMV and cystic fiborisis)
Chronic urticaria or mastocytosis (NSAIDs, opioids and other drugs with histamine releasing properties)
Drug dependant factors (beta-lactam antimicrobials, neuromuscular blocking agents, radiocontrast media, NSAIDs)
Frequent and prolonged doses
Sex - women more at risk
Topical application of drugs

Question 20

What co-existing conditions are risk factors to developing a drug allergy reaction?

Answer 20

HIV, EBV, CMV and cystic fibrosis

Question 21

In patients with chronic urticaria or mastocytosis, what drugs are they more likely to be sensitive to?

Answer 21

NSAIDs, opioids, other drugs with histamine releasing properties (e.g., atracurium)

Question 22

What drugs are more likely to result in an allergic reaction?

Answer 22

Beta-lactam antimicrobials, neuromuscular blocking agents, radiocontrast media, NSAIDs, high molecular weight starches

Question 23

What should you prescribe for a mild-moderate drug allergic reaction in an adult?

Answer 23

Chlorphenamine 4mg PO

Question 24

What two drugs should you prescribe for a patient who is being discharged after a moderate/severe anaphylactic reaction to a drug?

Answer 24

Prednisolone for up to 3 days
Non-sedating antihistamine for up to 3 days

Question 25

When should you prescribe adrenaline auto-injectors for a patient?

Answer 25

When there is a significant risk of re-exposure to the allergen after a moderate/severe anaphylactic reaction